内容紹介
Summary
Background: The efficacy and safety of chemotherapy for patients with lung cancer who are in need of intensive care, such as invasive mechanical ventilation, have not been established. Case: A 59-year-old woman consulted a doctor with complaints of dyspnea. She was intubated because of acute respiratory failure and transferred to our hospital. Enhanced CT images revealed advanced stenosis of her trachea due to a bulky mediastinal tumor. Cervical lymph node biopsy was performed, and she was diagnosed with mediastinal small cell lung cancer. She received combination chemotherapy with carboplatin and etoposide along with invasive mechanical ventilation. Chemotherapy was effective, and extubation was performed under careful bronchoscopic observation. Her general condition improved gradually, and she was discharged from our hospital on foot with ambulatory chemotherapy. Conclusion: Even though patients with lung cancer develop respiratory failure and need invasive mechanical ventilation, they may be treated with effective chemotherapy and may be weaned from ventilation.
要旨
背景: 人工呼吸管理などの集中治療が必要な肺癌患者に対する化学療法の有効性や安全性は確立していない。症例: 59歳,女性。呼吸困難を主訴に近医を受診し,急激に呼吸状態が悪化したために挿管され,当院に搬送となった。造影CTで縦隔に巨大な腫瘤を認め,気管は高度に圧排されていた。頸部リンパ節生検により縦隔型小細胞肺癌と診断し,挿管人工呼吸管理下にcarboplatinとetoposideによる化学療法を行った。化学療法は奏効し,人工呼吸器離脱に至った。その後,全身状態は徐々に改善したため外来で化学療法を継続することとし,独歩で退院となった。ただし,その後の化学療法は奏効せず,診断から約7か月後に死亡した。結論: 肺癌の進行による呼吸不全で挿管人工呼吸管理を要しても,化学療法の奏効により人工呼吸器を離脱できる症例がある。
目次
Background: The efficacy and safety of chemotherapy for patients with lung cancer who are in need of intensive care, such as invasive mechanical ventilation, have not been established. Case: A 59-year-old woman consulted a doctor with complaints of dyspnea. She was intubated because of acute respiratory failure and transferred to our hospital. Enhanced CT images revealed advanced stenosis of her trachea due to a bulky mediastinal tumor. Cervical lymph node biopsy was performed, and she was diagnosed with mediastinal small cell lung cancer. She received combination chemotherapy with carboplatin and etoposide along with invasive mechanical ventilation. Chemotherapy was effective, and extubation was performed under careful bronchoscopic observation. Her general condition improved gradually, and she was discharged from our hospital on foot with ambulatory chemotherapy. Conclusion: Even though patients with lung cancer develop respiratory failure and need invasive mechanical ventilation, they may be treated with effective chemotherapy and may be weaned from ventilation.
要旨
背景: 人工呼吸管理などの集中治療が必要な肺癌患者に対する化学療法の有効性や安全性は確立していない。症例: 59歳,女性。呼吸困難を主訴に近医を受診し,急激に呼吸状態が悪化したために挿管され,当院に搬送となった。造影CTで縦隔に巨大な腫瘤を認め,気管は高度に圧排されていた。頸部リンパ節生検により縦隔型小細胞肺癌と診断し,挿管人工呼吸管理下にcarboplatinとetoposideによる化学療法を行った。化学療法は奏効し,人工呼吸器離脱に至った。その後,全身状態は徐々に改善したため外来で化学療法を継続することとし,独歩で退院となった。ただし,その後の化学療法は奏効せず,診断から約7か月後に死亡した。結論: 肺癌の進行による呼吸不全で挿管人工呼吸管理を要しても,化学療法の奏効により人工呼吸器を離脱できる症例がある。